Treatments and Surgical Options for Gallbladder Disease

Open Surgery 

With open surgery, your surgeon makes a long abdominal cut/incision to reach your gallbladder. The incision must be large enough for your surgeon to fit his or her hands and surgical instruments inside your body. The open incision allows doctors to see and touch your organs while operating. 

Minimally Invasive Surgery 

The goal of minimally invasive surgery is to reduce your pain, hospital stay and recovery time. However, people who are obese or have a severe infection or inflammation in the gallbladder may not be candidates for minimally invasive surgery. 

• Traditional Laparoscopic Surgery: With laparoscopic surgery, your surgeon operates through a few small incisions. Long-handled instruments are inserted through the incisions. One of the instruments is a laparoscope – a thin, lighted tube with a tiny camera at the end. The camera takes images inside your body and sends them to a video monitor to guide doctors as they operate. 
• da Vinci® (Cholecystectomy) Surgery: Using the da Vinci® Surgical System, your surgeon makes just a few small incisions – similar to traditional laparoscopy. Minimally invasive da Vinci Surgery uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. 
• Single Incision Laparoscopic Surgery: With single incision laparoscopy, your surgeon operates through one small incision in the navel (belly button). As with traditional laparoscopy, a tiny camera sends images to a video monitor in the operating room to guide doctors as they remove your gallbladder. 
• da Vinci® Single-Site® Surgery: Another minimally invasive surgical option is da Vinci®Single-Site® Surgery. During da Vinci Single-Site Surgery, surgeons make one small incision in your belly button to remove your gallbladder – similar to single incision laparoscopy. The da Vinci System features a magnified 3D high-definition vision system. As a result, da Vinci enables your doctor to operate with enhanced vision and precision. 

While gallstones are often found during tests for other health conditions, some common tests for finding gallstones and gallbladder disease are: 

• Ultrasound: A technician glides a hand-held device over your stomach. The device sends sound waves to your gallbladder. The sound waves bounce off your gallbladder, liver, and other organs. The echoes make electrical impulses that create a picture of your gallbladder on a video monitor. If you have gallstones, the sound waves will also bounce off the stones and show their location. 
• Computerized tomography (CT) scan: An X-ray produces cross-section images of the abdomen. Your doctor reviews the images to find out if you have gallstones. 
• Cholescintigraphy (HIDA scan): A radioactive chemical or tracer is injected into a vein in your arm. Using imaging, the tracer is followed through your body to detect stones or problems with your gallbladder. 
• Endoscopic retrograde cholangiopancreatography (ERCP): During ERCP, a thin tube with a camera at the end is inserted down your throat to look for gallstones. If found, the stones can be removed during the test. You will be lightly sedated, so it will not be painful. 
• Blood tests: Blood tests may be performed to look for infection, obstruction, pancreatitis, or jaundice. 

Main Causes 

Your gallbladder may cause symptoms if something blocks the flow of bile through your cystic duct. The most common cause of a blockage is a gallstone. Doctors believe stones form when bile has too much cholesterol or not enough bile salts. Stones can also form if the gallbladder does not empty correctly. And, just having gallstones can cause more gallstones to form. 

Other Causes & Risk Factors 

There are other common causes for gallstones, including: 

• Gender: Women are twice as likely as men to have gallstones. Extra estrogen from pregnancy, hormone replacement therapy, or birth control pills may raise cholesterol levels in bile and decrease gallbladder movement. 
• Genetics: Gallstones often run in families. 
• Weight: Even being slightly overweight raises your risk for gallstones. Obesity is a major risk factor for gallstones. 
• Diet: A diet high in fat and cholesterol and low in fiber can cause gallstones to form. 
• Rapid weight loss: Rapid weight loss, fasting and “crash” dieting can cause your liver to release extra cholesterol, which can cause gallstones. 
• Age: People over age 60 are more likely to develop gallstones. 
• Ethnicity: Native Americans and Latino men have higher rates of gallstones. 
• Cholesterol-lowering drugs: Drugs that lower your cholesterol levels can increase the amount of cholesterol secreted into bile, which increases the risk of gallstones. 
• Diabetes: People with diabetes often have high levels of fatty acids called triglycerides. These fatty acids may increase the risk of gallstones. 

The cause of pigment gallstones is not fully understood. These stones tend to form in people who have liver cirrhosis (scarring of the liver), biliary tract infections, or hereditary blood disorders where the liver makes too much bilirubin (a waste product)

Signs and symptoms of gallbladder disease are often caused by gallstones that block your bile ducts. Gallstones occur when bile hardens in your gallbladder. 

Gallbladder symptoms are sometimes called “gallbladder attacks” because they can occur without warning. Gallbladder attacks often happen at night or after a high-fat meal. 

Common Symptoms 

• Steady pain in upper right side of your stomach 
• Pain increases quickly and lasts 30 minutes to several hours 
• Pain between your shoulder blades 
• Pain under your right shoulder 

If your symptoms get worse or include a fever, see a doctor immediately. An attack often goes away when gallstones move, but your gallbladder can become infected and rupture if the blockage remains. That’s why it is important to let your doctor know if you think you had a gallbladder attack. 

Severe Symptoms 

See a doctor immediately if you have any of the following symptoms or if your symptoms get worse: 

• Pain that lasts more than 4 hours 
• Nausea and vomiting 
• Chills or fever 
• Yellowish discoloration of the skin or whites of the eyes 
• Clay-colored stools 

Asymptomatic Stones 

If you have gallstones but no symptoms, these gallstones are called “asymptomatic stones”. They do not affect how your gallbladder, liver, or pancreas works.

Your gallbladder is a small pear-shaped organ under your liver. Your gallbladder and several ducts (tubes) are part of the biliary system. It acts as a storage tank for bile. Bile, also known as gall, is a fluid made by your liver to help digest fat. As your stomach and intestines digest food, your gallbladder releases bile through the common bile duct.  

You can live without your gallbladder. Similar to your tonsils, it serves a purpose but you can live a normal life without it. 

Other parts of your biliary system include: 

• Hepatic Bile Ducts: Carry bile out of the liver 
• Cystic Duct: Takes bile from the liver to store in the gallbladder
• Common Bile Duct: Takes bile from cystic and hepatic ducts to the small intestines 
• Pancreatic Duct: Carries digestive enzymes out of the pancreas